From the Guidelines
The tricuspid valve function appears normal with only physiologic trivial regurgitation, and no intervention is required as these findings represent normal cardiac hemodynamics. The inferior vena cava (IVC) caliber is 1.3 cm, which is within normal limits, suggesting normal right atrial pressure, as indicated in the 2014 AHA/ACC guideline for the management of patients with valvular heart disease 1. This is confirmed by the measured right atrial pressure of 3 mmHg, which is also normal. The tricuspid regurgitation velocity is 1.2 m/s, indicating a low pressure gradient across the valve.
According to the guidelines, a tricuspid regurgitation velocity of < 2.8 m/s excludes pulmonary hypertension (PH) in the absence of other echocardiographic variables suggestive of PH, as stated in the European Heart Journal 1. The low TR velocity further confirms the absence of elevated right ventricular systolic pressure. The normal IVC size and low right atrial pressure indicate adequate right heart function without evidence of right-sided heart failure or pulmonary hypertension.
Some key points to consider in this patient's evaluation include:
- The absence of significant tricuspid regurgitation or stenosis
- Normal IVC caliber and right atrial pressure
- Low tricuspid regurgitation velocity, indicating low pressure gradient across the valve
- No evidence of right-sided heart failure or pulmonary hypertension
Regular cardiac follow-up with routine echocardiography is appropriate to monitor for any changes over time, but no specific treatment is needed for the tricuspid valve at this time, as the current findings are consistent with normal cardiac hemodynamics, according to the guidelines 1.
From the Research
Tricuspid Valve Structure and Function
- The tricuspid valve is a complex structure with a broad anatomical variability 2
- Tricuspid regurgitation (TR) is present in 1.6 million individuals in the United States and 3.0 million people in Europe 3
- TR can be classified into two basic categories: primary and secondary TR, with secondary TR being the most common form 4, 2
Diagnosis and Assessment of Tricuspid Regurgitation
- Echocardiography can assess the TR etiology/severity, measure RA and RV size and function, estimate pulmonary pressure, and characterize LV disease 3
- Advanced three-dimensional echocardiography, MRI, and CT are gaining in clinical application for the assessment of TR 5, 6
- The current guidelines-recommended multi-parametric echocardiographic approach has strengths and limitations, and multi-modality imaging can play a role in the management of the disease 6
Management and Treatment of Tricuspid Regurgitation
- Management includes diuretics, ACE inhibitors, and aldosterone antagonists 3
- Surgical annuloplasty or valve replacement should be considered in patients with progressive RV dilatation without severe LV dysfunction and pulmonary hypertension 3, 5
- Transcatheter repair/replacement is possible in patients with a LVEF <40%, dilated annuli, and impaired RV function 3, 2
- Novel transcatheter therapies have begun to emerge for the treatment of TR in patients who are deemed at very high or prohibitive surgical risk 5, 2
Prognosis and Outcome
- Significant TR is an independent predictor of reduced event-free and overall survival 4
- The five-year survival with severe TR and HFrEF is 34% 3
- Appreciable evidence suggests that significant TR leads to worsening prognosis regardless of the underlying etiology and should be addressed as a separate therapeutic target 2